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RATIONALE: Eosinophilic esophagitis (EoE) is an increasing, allergic disease with variable symptoms that progress with age. While adult predominant studies have shown symptoms differ significantly in male and female patients, no pediatric studies have been performed. We compared clinical features by sex in a pediatric EoE cohort. METHODS: At endoscopy, 98 EoE patients were recruited for a cross sectional study. Participants completed demographic and clinical questionnaires and medical records were reviewed for esophageal biopsy results. RESULTS: In the whole cohort, ages ranged from 2 to 19 (median 12) and 89% were white. There were 39 female and 59 male patients, and there were no significant sex-related differences in race, body mass index (BMI), concurrent allergic diseases, peak esophageal eosinophil counts, or symptoms. For further analysis, patients were divided into four groups based on sex and age: i) males<13, ii) males> _13, iii) females<13, and iv) females> _13. Prevalence of reported food allergies was higher in male patients<13 (65%, p50.005). Peak eosinophil counts were higher in males> _13 compared with females> _13 [median 63 eosinophils/high power field (eos/hpf) and 44 eos/hpf respectively, p50.045]. Females> _13 were more likely to have abdominal pain (68%, p50.01), and males> _13 were more likely to report food impactions (78%, p50.005). BMI was lowest in females<13 and highest in females>13 (p<0.001). Histologic remission was significantly less frequent in males<13 (31%) compared with females<13 (69%) (p50.043). CONCLUSIONS: There were age-related sex differences in symptoms, markers of allergy, and outcomes in pediatric EoE patients. These group differences appear to result from separate changes in both sexes after adolescence.

RATIONALE: Food protein-induced allergic proctocolitis (FPIAP) is an early, common, and burdensome manifestation of food allergy. Yet, its epidemiology, pathophysiology and relationship to other food allergic manifestations remain poorly understood. METHODS: The Gastrointestinal Microbiome and Allergic Proctocolitis (GMAP) Study is an ongoing prospective observational infant cohort which enrolled 1003 healthy newborn infants at their first well visit at a single primary care practice in suburban Massachusetts and followed them for a median of 24 [2, 45] months. Clinical diagnosis of FPIAP including documented blood in stool was made by expert clinicians. RESULTS: 903 infants were analyzed (46% female, 89% term, 32% delivered via caesarian section, 9% neonatal antibiotics). 153 cases of FPIAP were identified, giving a cumulative incidence of FPIAP in this unselected population of 17% over three years. Infants fed both breastmilk and formula at any point during the first 4 months were 56% less likely than infants fed exclusively formula and 38% less likely than infants fed exclusively breastmilk to develop FPIAP (HR 0.44, p50.005; HR 0.62, p<0.050). Eczema (OR 1.5 [1.1, 2.2], p50.021) and family history of food allergies (OR 1.9 [1.2, 2.8], p50.005) were among risk factors for FPIAP development, while caesarian section, antibiotic exposure, and siblings were not. Infants fed exclusively formula developed FPIAP at a significantly younger age than those exposed to breastmilk (15.6 vs. 32.4 days, p<0.001). CONCLUSIONS: The prospectively defined incidence of FPIAP is strikingly higher than published estimates. Infants fed both formula and breastmilk appeared most protected against FPIAP development.

RATIONALE: Eosinophilic Esophagitis (EoE) is a condition with an increasing frequency, i ts relevant studying natural evolution of allergic diseases, considering EoE as a part of these conditions METHODS: We performed a retrospective analysis of 71 EoE patients. The objective was to describe the frequency of atopies and IgE mediated food allergy. We evaluated demographics, EoE family history, symptoms onset, diagnosis age, IgE aeroallergen and food sensitization RESULTS: We found diagnosis mean of age was 18 yo (5-78 yo). Time between symptoms onset and EoE diagnosis was 2.86 years. We found male predominance 48/71 (67.70%). The most prevalent atopy was allergic rhinitis (49/71-69.01%), IgE-mediated food allergy (39/71-54.92%), allergic asthma (29/71-40.84%) and atopic dermatitis (12/71-16.90%). Between IgE-mediated food allergy patients, 71.79% presents anaphylaxis history. Eleven patients (15.49%) only have EoE. IgE food sensitization (26/71-36.61%) was more frequent than aeroallergen (5/71-7.04%), being 27 patients (38.02%) with dual IgE sensitization (food and aeroallergen), 26 only food sensitization, 5 only aeroallergen sensitizations. Thirteen patients (18.30%) didn't have any IgE sensitization. About the relationship between food allergy and EoE evolution, found that patients with IgE food reactions preceded the diagnosis of EoE 38/39 (97.43%) CONCLUSIONS: We observed high prevalence of atopic conditions. Food IgE sensitization was important despite most of our patients were adolescents and adults. It's important to follow up food worsening EoE even in older patients. In most cases of IgE mediated food allergies, anaphylaxis history warns us about the possibility that atopic patients that developed EoE could be associated with severe food allergy phenotype RATIONALE: Eosinophilic esophagitis (EoE) is characterized by esophageal dysfunction with eosinophilic inflammation. Severe forms (fibrostenotic) are more frequently described in adults, due to the chronic, progressive evolution of the disease. We analyzed clinical, endoscopic, anatomopathological aspects of children with EoE. METHODS: Retrospective analysis (2001-2017) of 23 children, 0-16 years old (yo), followed-up at a Brazilian teaching hospital. RESULTS: 78,3% boys (n518), 4 yo [1. .83] at the onset of symptoms, 7.46 (SD64.28) yo when diagnosed. Symptoms: abdominal

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